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Does COVID-19 Increase Mortality in Stroke?

GLOBAL COVID-19 Stroke Registry data show that acute ischaemic strokes (AIS) that occur in conjunction with COVID-19 are more severe and associated with higher mortality. Patients with COVID-19 and AIS have worse functional outcomes because of the diverse range of complications associated with the viral disease.

Severe stroke is typically linked with poor prognosis; given the recent pathophysiological association between COVID-19 and AIS from small case studies, confirmation of this relationship is pivotal. To determine the clinical characteristics and outcomes of patients with COVID-19 and AIS, researchers analysed COVID-19 patient data from 28 healthcare centres in 16 countries, using the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) registry, and compared them to patients without COVID-19.

The study used information on 174 patients hospitalised between January 27th to May 19th 2020 with COVID-19 and AIS. Using a set of prespecified factors including age, sex, and stroke factors (hypertension, diabetes, atrial fibrillation, coronary artery disease, heart failure, cancer, previous stroke, smoking, obesity, and dyslipidaemia) each patient with COVID-19 and AIS was matched and compared to a patient following AIS without COVID-19. Stoke severity was estimated with the National Institute of Health Stroke Scale (NIHSS) and stroke outcome was assessed by the modified Rankin score (mRS) in both patient groups (N=330).

Results highlighted that with a median NIHSS score of 10 versus 6, respectively, the patients with COVID-19 had more severe strokes, had higher risk for severe disability following stroke (median mRS score: 4 versus 2, respectively), and were more likely to die of AIS. According to the researchers: “The increased stroke severity at admission in COVID-19-associated stroke patients compared to the non-COVID-19 cohort may explain the worse outcomes.”

They further noted that the multitude of complications of COVID-19, including acute respiratory distress syndrome, cardiac arrhythmias, acute cardiac injury, shock, pulmonary embolism, and secondary infection, further contribute to the worse outcomes in patients with COVID-19 and AIS. The team explained the importance of these findings: “The association highlights the urgent need for studies aiming to uncover the underlying mechanisms and is relevant for prehospital stroke awareness and in-hospital acute stroke pathways during the current and future pandemics.”